Injection Drug Use Helps Drive HIV/AIDS in Africa

From CDC National Prevention Information Network

May 6, 2011

In many countries experiencing a stabilizing of HIV incidence, the proportion of injection drug use (IDU)-related infections is increasing, say researchers with the Center for Strategic and International Studies (CSIS) in Washington.

The problem is evident in sub-Saharan Africa, where heroin routes have expanded. The uptick in African IDU-related infections is traceable to the late 1990s, when "white" heroin became available in East Africa.

"I think the whole question of [IDU] and HIV prevention has been one that's really under-resourced and not really paid adequate attention to, either from a policy or a programmatic point of view," said Lisa Carty, co-author of a CSIS report on the problem.

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Epidemiological data of the type needed for planning and effective treatment and prevention programs remain patchy, says the CSIS report.

Coastal areas such as Mombasa, Zanzibar, and Dar es Salaam "have become more and more an entry point for drug trafficking out of the South Asia region, in through Africa and then, very often, up through Europe and on to the United States," Carty said.

Women are especially at risk, since "many women who inject drugs turn to sex as a way of raising money to buy drugs," said report co-author Dr. Phil Nieberg, senior associate with Global Health Policy Center. "So there's an overlap between sex work and drug use." Ironically, even male IDUs disparage female drug injectors, he said.

Treating addiction as a disease rather than a crime could encourage more addicts to seek help, Nieberg and Carty said. Counseling, needle-exchange programs, and methadone maintenance treatment could be a part of that, they said. Law enforcement efforts tend to push IDUs further away from care and treatments, a situation that affects sex workers as well as men who have sex with men.

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